Outsmarting epidemics

Obesity has become a significant public health issue and with good reason. Over the past 40 years, the number of people living with obesity has almost tripled. Today, more than 650 million adults worldwide have obesity - that’s double the total population of the United States. Furthermore, more than 120 million children and adolescents are living with obesity and a further 210 million are overweight, putting them at risk of having obesity in adulthood.

The World Obesity Federation estimates that obesity accounts for a staggering $850 billion of direct healthcare costs globally. If action is not taken, the medical bill for treating the health complications associated with obesity is expected to climb to $1.2 trillion by 2025.

Obesity is increasing across the globe

Image: Institute for Health Metrics and Evaluation, University of Washington

This is a global crisis, with profound social, economic, and health implications for individuals and their communities. What these facts highlight is the need for a sense of urgency in the debate.

"I was 28 years old and 400lbs/180 kg. I was a mum of two children, two wonderful little boys, and I was married. In many ways, I was happy with my life, but I was very depressed. I didn't want to talk about it. I didn't want to acknowledge my weight problem. People ask: "How did you get to this weight? How did you get to 400 l?"

—Vicki Mooney, General Secretariat of the EASO Patients Council, Ireland.

Obesity is a complex disease and is not caused by a lack of willpower. Unfortunately, incorrect and outdated perceptions about the causes of obesity are an underlying factor holding back decisive action on this pandemic. There is significant scientific evidence proving that obesity is a complex disease brought on and sustained by many factors which are beyond the individual’s control. For example, nearly 100 genes have been identified that are related to obesity.

Many factors influence a person's metabolic balance throughout their life

Image: World Obesity Federation

Struggling with weight loss maintenance is not a personality weakness

Losing weight and maintaining the loss is a challenge many of us have experienced. The difficulty with weight loss is that it activates several hormonal changes in our bodies that favour weight regain that persists for many years. For a person living with obesity, the challenge can be almost insurmountable and further impeded by complications brought on by the disease. Only one in 10 people with obesity can maintain weight loss for more than one year after losing weight.8,9

There is still much to learn about the causes and impact of obesity in people’s everyday lives, and also about how we should treat people who have obesity. As Donna Kasznel from Kentucky, USA explains: “I’ve been overweight for most of my adult life and have always been ashamed of it. Unlike some other diseases, obesity isn’t something that you can keep a secret. It’s the first thing people see when they meet you, and you’re immediately judged based on your appearance. Obesity is relentless – it affects everything you do all day, every day, and permeates all aspects of your life – from what you wear to where you park, to the seat you choose, or whether you can even participate in certain things.”

Five priorities to realise change

Although changing the narrative around obesity may not be easy and will take time, only by recognising obesity as a chronic disease can governments and healthcare services adequately prioritise and fund its effective prevention and treatment and reduce the burden on individuals as well as society.

Central to this is adopting a new narrative and philosophy in which understanding and respect for the individual are key. This involves:

1. Recognising that obesity is a disease with very complex factors underlying its development

2. Acknowledging the daily struggle faced by people with obesity, confronted by a world where biological, social and environmental forces negatively influence their ability to manage their body weight. Obesity, as a public health concern, therefore requires both prevention and treatment strategies to bring it under control

3. Training healthcare workers to use appropriate language to successfully engage people on the topic of their weight by avoiding for example terms such as “heaviness”, “large size” or “fatness”

4. Leveraging multi-disciplinary social service and healthcare teams to support people managing their chronic disease, allowing them to live their life with few restrictions

5. Advocating for a people-centric approach to change how the world sees people with obesity so as to make obesity prevention and treatment a healthcare priority

Supporting people with obesity is a win-win strategy

Three years ago, world leaders adopted the UN’s 17 sustainable development goals (SDGs) , which cover a broad range of social and economic development issues. Without addressing obesity, attainment of many of these goals will remain beyond our grasp.10

For example, SDG 3 is about ensuring healthy lives and promoting wellbeing for all, at all ages. One associated target is to reduce premature mortality from non-communicable diseases (NCDs) by one-third by 2030 through prevention and treatment, and promoting mental health and wellbeing.

Obesity is associated with a range of chronic diseases that are directly responsible for the majority of NCD-related deaths. These include cardiovascular disease, type 2 diabetes and various cancers.

Obesity can lead to multiple health complications

Image: World Obesity Federation

For people with obesity, weight loss of 5–10% is associated with a reduction in the risk and severity of NCDs and improved health-related quality of life.11,12 Considering the healthcare costs for treating obesity-related conditions, it makes sense to focus on how we can support people with obesity to lose weight and keep it off.

Changing the narrative may not be easy, nor will it happen quickly - but a shift in how we talk about obesity and the people it impacts needs to take place at all levels of society. Only then will systems adequately prioritise and fund its effective prevention and treatment to reduce the burden on both individuals and society.